By Robert E. Moffit – WASHINGTON, D.C. — Among President Obama’s broken promises, there is this gem of June 15, 2009: “…no matter how we reform healthcare, we will keep this promise: if you like your doctor, you will be able to keep your doctor. Period.”
That promise helped sway the American Medical Association to back the president’s Affordable Care Act, commonly known as Obamacare. But the AMA endorsement merely reflected a tremendous gap between its Washington lobbyists and the folks they claim to represent.
In 2011, a Jackson & Coker survey found that 70 percent of doctors disagreed with the AMA position supporting the law.
It gets worse. Last year, a Physicians Foundation survey found that as a result of the Affordable Care Act about three of every five physicians were “less positive” about the future of American healthcare, and more than a third planned to restrict their Medicare or Medicaid practice.
Doctors are demoralized and feel powerless. Obamacare never addressed physicians’ most pressing concerns — particularly the need for medical tort reform. It completely ignored the already difficult problems physicians face with Medicare payments, which are below market rates.
Worse, the law created the Independent Payment Advisory Board, a bureau charged with cutting Medicare payments even more.
The new law also turned the heavy flow of government red tape into a gusher. A 2012 Physicians Foundation survey found that almost four of every five respondents — 79.2 percent — identified too much regulation and paperwork was a “very important” reason why the medical profession is in decline.
Consider the facts. With more than 13,000 pages of regulations thus far, and more to come, the Affordable Care Act will make running a medical practice even more stultifying and sclerotic.
In addition to the mountain of paperwork under which they already labor, doctors will be faced with reams of new bureaucratic requirements such as new Medicare rules governing patient referrals and reporting, new rules governing practice standards, plus tougher civil monetary penalties and criminal sanctions.
None of this will make the practice of medicine more attractive or enticing. The November 9, 2010, edition of Medscape Family Medicine, quotes an internist as saying: “If dealing with Medicare was a headache, dealing with the new bureaucracy will be an intracranial hemorrhage.”
Even before Obamacare, America faced a shortage of physicians — particularly in geriatrics and primary care. The American Association of Medical Colleges predicts a shortage of 124,000 physicians by 2025. Older doctors will retire, but will they be replaced in sufficient numbers?
If you’re a young doctor, finishing four years of medical school after college, plus a three or more years of a residency, plus further training through a fellowship, you will start your career with an accumulated debt averaging $150,000 and the prospect of going to bureaucrat obedience school.
Fewer doctors, meanwhile, will accept new Medicare and Medicaid patients. It’s not the patients, it’s the bureaucratic baggage, combined with sub-par reimbursements and inflexible price controls.
Expect even more doctors to abandon private solo practice, go to work for hospitals or join big group practices. Expect even greater consolidation of healthcare markets and less competition.
Real healthcare reform would restore the traditional doctor-patient relationship. In such a relationship, physicians would be the key decision-makers in the delivery of care, and patients would be the key decision-makers in the financing of care.
That can’t happen unless and until patients control healthcare dollars and decisions, and third-party insurance executives are directly accountable to those who pay the healthcare bills. In other words, that can’t happen unless and until Congress repeals and replaces Obamacare.
The President’s promises were lofty and empty. The real issue is not whether you can keep your doctor; it’s whether your doctor can keep you.
Robert E. Moffit is a senior fellow with the Center for Policy Innovation at The Heritage Foundation (heritage.org), a conservative think-tank on Capitol Hill.
The Jackson and Coker survey cited here is completely unscientific; less than 1.5 percent of those who received the survey chose to respond. AMA policy is set democratically by our House of Delegates with members from all states and virtually all medical specialties. The physicians who set AMA policy believe covering America’s uninsured – who live sicker and die younger – is critical. As the nation’s largest physician organization, the AMA is engaged in the implementation of the health reform law to achieve improvements and ensure the best outcome for patients and physicians. We are pleased that the new law extends coverage to millions of Americans, ends insurance company denials based on pre-existing conditions and promotes wellness and prevention – all while retaining our American health care system’s mix of public and private insurers. The law also includes increased payments for primary care physicians in Medicare and Medicaid and bonus payments for general surgeons in underserved areas. We are leading the charge to address problematic parts of the new law, including eliminating the Independent Payment Advisory Board, to ensure it meets the needs of patients and the physicians who care for them.
Not correct AMA! The AMA's initial support of Obamacare was not voted on by the membership. In point of fact, a majority of the membership both then and now is against Obamacare in its current form. To be clear they are against what it is doing to the patient/Doctor relationship as well as the non-adressing of other issues like tort reform. Get your facts right before post again please.
Mr. Moffit seems to support the historic paternalistic model of physician decision-making in health care clinical practice… the very model we're trying to dismantle not only because there are very competent non-physician providers in practice, but because the patient must be the primary decision-maker. It is the patient's own body, and that ownership does not transfer when the patient agrees to pay the provider for a service. The patient is a consumer of goods and services by the health care providers and ancillary service providers, and should be the decision-maker on all levels. Yes, that can and should be a collaborative relationship. I'm not saying that Obamacare brings us closer to achieving that consumer independence, but supporting the old model keeps us in a historically bad model where patients are stripped of their right to choose for themselves.
I think that if we eliminate medicare and allow doctors,for profit hospitals and all licensed and unlicensed medical practitioners to pool their resources privately in afree and open market without ant federal gov't involvement.medicare is an unfunded liability.it is draining our country's wealth and economic energy.it imposes a heavy burden on all tax-payers and especially our younger generation work force who would benefit by opting out of the federal medicare program.and the senior citizens that have been involuntarily paying into medicare thruout their working lives?now more than ever they are worrie about their health and wellbeing.in afree market.they would pay for medical services.doctors and hospitals would have to compete and we would have lower costs.for the truly needy,private charities.family and free services will be provided.and what about catastrophic accidents.again the medical practitioners will resolve payments in a free open market and a free society.
With more than 13,000 pages of regulations thus far, and more to come, the Affordable Care Act will make running a medical practice even more stultifying and sclerotic.
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